Provider Demographics
NPI:1497710065
Name:GREEN MOUNTAIN ORTHOPAEDIC SURGERY, PC
Entity Type:Organization
Organization Name:GREEN MOUNTAIN ORTHOPAEDIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-229-2663
Mailing Address - Street 1:130 FISHER RD
Mailing Address - Street 2:BUILDING A, SUITE 2-2
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9516
Mailing Address - Country:US
Mailing Address - Phone:802-229-2663
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:BUILDING A, SUITE 2-2
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-229-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
VT6499280001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6499280001OtherMEDICARE PTAN
NH30216639Medicaid
VT1009345Medicaid
VT6499280001OtherMEDICARE PTAN